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Applicant Information : SLU - Saint Louis University

Application Process

The Internal Medicine Residency Program currently has 29 available third-year (categorical) positions and six to seven first-year (preliminary) positions. Four of the first-year positions will automatically be filled by newly-matched opthalmology residents. 

Applicants should apply through the Electronic Residency Application Service (ERAS) and register for the National Resident Matching Program (NRMP) by using one of the following codes:

Categorical: 1365140C0

Preliminary: 1365140P0

Applicant Review

Program leaders select a group of applicants for comprehensive review. Selections are based on a range of factors, including geographic location, medical school, program signal and connection to St. Louis/SSM Health/Saint Louis University. A program signal is not required but indicates strong interest and will be weighed accordingly. 

These applicants are then selected for interviews based on scores from a values-based algorithm that integrates medical school performance, commitment to the program's mission, leadership potential and service. If there is a tie score, preference is given to the applicant who signaled interest in the program. 

Seeking Evidence of Character and Growth

Applicants are unique humans and have different experiences with success and failure. As internists, program leaders seek context and nuance. 

One low or failing USMLE or COMPLEX score does not disqualify an otherwise impressive candidate. Did they experience an unfortunate circumstance? Can they demonstrate lessons learned?

There is more to being a good physician than passing tests. Is the candidate committed to an aspect of Saint Louis University School of Medicine's Catholic, Jesuit mission, such as service, leadership or advocacy?

Clinical clerkship allows medical students to apply skills and knowledge in real-world clinical settings. How did the candidate interact with patients during this training? What is highlighted in their letters of recommendation?

Study Says Limits On Residency Work Hours Didn't Affect Doctor Performance

Physician training has long been notorious for marathon shifts, sleepless nights on call, and holidays worked. But that began to change in 2003, when the medical profession placed restrictions on work hours during residency. However, experts wondered, can we train residents in fewer hours and still make good doctors?

A new study in the BMJ says yes. The researchers, led by Dr. Anupam Jena, a professor of health care policy and medicine at Harvard Medical School, looked at the performance of internal medicine doctors in their first year of unsupervised medical practice after completing their training.

They compared the outcomes for patients of two groups of physicians: those trained before 2003, when the typical work week was 100 hours; and those trained later under the new rules, which capped weekly hours at a mere 80, with no individual shift exceeding 30 hours. For the three quality measures examined — mortality within 30 days of being hospitalized, readmissions, and hospital services used (a measure of efficiency) — they found no differences between the groups.

Looking at the data for just the sickest patients in the hospital, a "group of patients for whom the experience and training of a doctor is really important," said Jena, the authors again found no difference in these three outcomes.

"If anything, it's reassuring," said Dr. Sanjay Desai, director of the internal medicine residency program at Johns Hopkins who was not involved in the study.

Jena and his team based their analysis on a random sampling of patient records from the Medicare database, including 450,000 hospitalizations at over 4,000 hospitals in the U.S., for each year from 2000 to 2012. 

Though the data are old, Desai said it's a timely paper. Other reforms were made after 2003, but the 80-hour cap and 30-hour shift limits studied in this paper are similar to what's in practice today, he said. Since 2017, when the latest reform was implemented by the Accreditation Council for Graduate Medical Education, the cap remains 80 clinical and educational work hours per week averaged over a four-week period, with no shift exceeding 28 hours.

Dr. Thomas J. Nasca, CEO of the accreditation group, said in a statement that the study supports its work rule, "which allows for flexibility within maximums while supporting patient safety, quality improvement, and physician well-being."

Jena said he chose to study only the first year of a new doctor's career because that's when the effects of residency training should be most evident. "If doctors who just completed a residency had insufficient training during residency because they worked fewer hours," he said, "then we should expect to see some differences really early on" before "real world" experience.

In 2006, co-author Dr. Jay Bhattacharya, professor of medicine and economics at Stanford University, looked at mortality of patients treated by residents before and after the changes implemented in 2003. He found that capping weekly hours decreased short-term mortality among high-risk patients. 

"Previous literature said that tired doctors hurt and kill patients. In 2006, short-term results showed that lower hours during residency reduced mortality in hospitals. But no one had assessed long-running quality of doctors," said Bhattacharya.

"This study is unique because it studied outcomes after training," said Desai.

The study also found that physicians with 10 years of experience provided higher quality care than the first-year doctors, as expected, but the gap in care was the same whether the new doctors trained before or after the cap was put in place. Over the 10 years studied, the study team also noticed a decrease in overall mortality, which accounts for nationwide trends that suggest hospitals are providing better care overall, said Jena. 

The authors noted that in the hospital setting, physicians work in big teams with specialists, nurses, social workers, and other advanced practitioners, which mutes the impact of any single physician on patient outcomes. 

What we need to know next, said Desai, is what residents are doing with their 80 hours. How much time is spent with patients? At the computer? Doing procedures?

"The real meaning in the hospital is where you spend those hours," said Desai. "In addition to [examining] patient safety outcomes, we need to think very hard and study more rigorously how physicians are shaped" during residency. 

A limitation of the study, mentioned by both Desai and the authors, is that it looked only at one specialty — internal medicine doctors. Surgeons and other doctors who perform procedures may be affected differently by hour restrictions because it would limit the number of procedures they perform under supervision. 

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